Volunteer Application Form

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Please fill out the below form. Please note that we have an 8 week minimum volunteer rotation. Once completed we will have our office contact you as availability opens! Thank you for your interest and we look forward to learning more about you!

First Name *

Last Name *

Address *

Phone *

Email *

What discipline are you interested in? *

Occupational Therapy

Physical Therapy

Speech Therapy

Required

Why do you want to volunteer at Milestone Pediatric Therapy? *

Do you have experience working with children? *

What do you hope to learn from volunteering at Milestone Pediatric Therapy? *

How many hours are you able to commit to each week? *

When do you hope to start and what day would be your last? *

Ideal day(s) and hour(s) for being in the clinic? *

Are you interested in volunteering with our aquatic therapy program on Wednesdays or Fridays, 7:45am to 11am? *

Yes

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